Provider Demographics
NPI:1851751945
Name:DALACK, JOHN DONALD II
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DONALD
Last Name:DALACK
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 GOLFVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-1922
Mailing Address - Country:US
Mailing Address - Phone:561-427-7620
Mailing Address - Fax:
Practice Address - Street 1:126 CENTER ST
Practice Address - Street 2:SUITE B7
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4373
Practice Address - Country:US
Practice Address - Phone:561-427-7620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3620324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility